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Fewer Psychiatrists Seen Taking Health Insurance

WASHINGTON — Psychiatrists are significantly less likely than doctors in other specialties to accept insurance, researchers say in a new study, complicating the push to increase access to mental health care.

The study, published Wednesday in the journal JAMA Psychiatry, found that 55 percent of psychiatrists accepted private insurance, compared with 89 percent of other doctors.

Likewise, the study said, 55 percent of psychiatrists accept patients covered by Medicare, against 86 percent of other doctors. And 43 percent of psychiatrists accept Medicaid, which provides coverage for low-income people, while 73 percent of other doctors do.

The lead author of the study, Dr. Tara F. Bishop of Weill Cornell Medical College in New York, said: “In the wake of the school killings in Newtown, Conn., and other recent mass shootings, the need for increased mental health services is now recognized. But unless patients have deep pockets, they may have a hard time finding a psychiatrist who will treat them.”

Mental health care is one of 10 types of “essential health benefits” that must be provided by insurers under the new health care law. A federal rule issued last month requires insurers to cover care for mental health and addiction on the same terms as treatments for physical illnesses, without charging higher co-payments or deductibles or imposing stricter limits on services. Starting next year, Medicare will end a discriminatory policy that for decades has required people to pay a larger share of the bill for mental health care than for other outpatient services.

However, the study suggests that expanding coverage may not by itself guarantee access to psychiatrists. “Even if you have good insurance that covers mental health care, you may still have a problem if there’s no doctor who accepts your insurance,” Dr. Bishop said.

Dr. Steven S. Sharfstein, a former president of the American Psychiatric Association, suggested several reasons for the disparities. Payments by insurers for many services provided by psychiatrists are relatively low, Dr. Sharfstein said. Treatment is often subject to burdensome and intrusive review by managed care companies, he said, and “there are always concerns about confidentiality.”

“Many psychiatrists do not take insurance,” said Dr. Sharfstein, who is president of the Sheppard Pratt Health System in Baltimore. “They have an out-of-pocket practice. They charge what they can, but they are flexible and will set rates on a sliding scale.”

The study also found that the acceptance of insurance had declined much more among psychiatrists than among other doctors.

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A possible reason, the authors said, is that the supply of psychiatrists is not increasing as fast as the demand. “As a result,” they wrote, “many psychiatrists may have so much demand for their services that they do not need to accept insurance.”

Another factor, they said, is that psychiatrists are more likely than other doctors to practice on their own, and solo practitioners, regardless of specialty, are less likely to accept insurance, in part because they do not have the back-office staff to deal with insurance companies.

Insurance payment rates for psychiatry are similar to those for many services provided in office visits by primary care doctors, the study’s authors said. But, they said, psychiatrists may be more reluctant to accept insurance because it takes more time to provide counseling and therapy, and psychiatrists may be unable to generate as much income per hour as doctors seeing larger numbers of patients.

“Psychiatrists may not be able to see as many patients in a day as physicians in other specialties,” the authors said. “Psychiatrists who want to provide psychotherapy may opt not to accept insurance.”

Dr. Bishop, a specialist in internal medicine, said she became interested in the issue after she had difficulty arranging mental health services for some of her patients. Co-authors of the study include Dr. Harold Alan Pincus, the vice chairman of the psychiatry department at Columbia University’s College of Physicians and Surgeons.

The study is based on data collected from doctors’ offices in surveys by the National Center for Health Statistics, a unit of the federal Centers for Disease Control and Prevention.

The Obama administration said Wednesday that $50 million from the new health law would be made available to community health centers to expand services for people with mental illness or addiction problems.

A version of this article appears in print on December 12, 2013, on Page A24 of the New York edition with the headline: Fewer Psychiatrists Seen Taking Health Insurance. Order Reprints|Today's Paper|Subscribe